MEDICARE: TERESA MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G15628	CA
2	207VX0000X	Obstetrics Physician	A70290	CA
3	208000000X	Pediatrics Physician	G15628	CA
4	207VG0400X	Gynecology Physician	A70290	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205056033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERESA MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	326 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-3511
Country	:	US
Telephone Number	:	323-660-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1407 N VERMONT AVE # A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6023
Country	:	US
Telephone Number	:	310-908-1007
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ARJANG NAIM
Credential	:	M.D.
Telephone Number	:	323-660-5900

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	03/20/2012

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Directions to “TERESA MEDICAL CENTER, INC. ” Practice Location

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